This text was initially printed by Undark Journal.
Amongst Lexie Manion’s reminiscences of her junior 12 months of highschool in New Jersey was the expertise of being often hassled by a college nurse who was making an attempt to weigh her.
The nurse, Manion recalled, was making an attempt to get Manion’s weight on file—a standard observe at faculties throughout america, which goal to make use of the information to enhance scholar well being. However for Manion, who had an consuming dysfunction, the expertise was deeply distressing. The considered getting on a scale in class—of somebody aside from her physician dealing with this delicate measurement—terrified Manion. It additionally triggered her consuming dysfunction: She started to limit her meals consumption extra intensely to drop some pounds earlier than the varsity nurse put her on a scale.
“I used to be apprehensive about her realizing my weight, and I used to be apprehensive the entire faculty would one way or the other know the quantity if she weighed me,” Manion, now 29, wrote in an e mail to Undark. “I turned very anxious and would keep away from the size and her gaze each time she inquired.”
The coverage at Manion’s faculty was a part of a nationwide effort to fight childhood weight problems by accumulating—and infrequently sharing—knowledge on college students’ weight. Beginning in 2003, one examine discovered, 29 states enacted insurance policies encouraging or requiring faculty districts to weigh college students, or to go additional and calculate their body-mass index, or BMI: a standard software for categorizing individuals based mostly on their weight and peak. By the coverage’s peak extent, within the 2010s, tens of millions of scholars every year have been receiving so-called “BMI report playing cards” within the mail—and a few college students even noticed their weight standing seem on their precise report playing cards, alongside their grades. Coverage makers hoped that by telling college students and their household a couple of baby’s weight class, the stories would immediate them to make more healthy decisions and drop some pounds, lowering childhood weight problems one scholar at a time.
However even because the observe was turning into extra widespread, analysis was already suggesting that BMI screenings don’t have any affect on college students’ weight and may even trigger hurt. At this time, many specialists say, the proof is obvious that faculty BMI screenings do little to enhance scholar well being. Analysis has additionally linked the coverage to elevated weight-based bullying and body-image dissatisfaction, which, as in Manion’s expertise, can set off or worsen consuming problems. In response, some states, together with California, have stopped requiring screenings.
However, BMI screening or comparable insurance policies that mandate or encourage weight-tracking stay on the books in no less than 16 states, together with Tennessee, West Virginia, Arkansas, and New York, in accordance with Undark’s assessment of state legislative codes.
“To focus efforts on simply measuring the rising waistline of America is a Band-Support,” says Kristine Madsen, a pediatrician and a public-health vitamin researcher at UC Berkeley, who performed one of many largest research of college BMI screenings so far. “It doesn’t even contact the underlying downside, and it’s ineffective.”
Arkansas was the first state within the nation to mandate screening and reporting, again in 2003. Then, in 2005, the Institute of Drugs on the Nationwide Academy of Sciences launched a 434-page report, “Stopping Childhood Weight problems: Well being within the Steadiness,” that urged extra states to undertake the observe. “It’s important for fogeys to have details about their baby’s BMI and different weight-status and bodily health measures, simply as they want details about different well being or educational issues,” the NAS group wrote.
The group was responding to what it described as a childhood-obesity epidemic. On the time, about one-third of U.S. kids have been classed as obese, overweight, or severely overweight. Childhood weight problems is linked to a spread of poor well being outcomes, together with hypertension, bronchial asthma, and coronary heart illness.
Extra states moved to implement BMI screening. By 2010, simply 5 years after the NAS’s suggestion was printed, 29 states have been broadly conducting some type of physique evaluation on their college students, in accordance with an instructional survey of state schooling departments.
These insurance policies usually supplied little steerage on how the weigh-ins needs to be performed. In keeping with one examine, about half of screenings have been accomplished throughout fitness center class, usually in entrance of different college students. The fitness center trainer or faculty nurse would measure every scholar’s peak and weight and submit them to the varsity, which, in lots of circumstances, would cross the information alongside to state well being authorities for population-level monitoring.
Baked into that mannequin from the beginning, some specialists say, have been issues. Foremost amongst them was, in lots of insurance policies, the reliance on BMI.
The 1832 paper that first proposed the metric, and the 1972 examine that sparked its fashionable utilization, concerned solely males and weren’t consultant of the ethnic and racial range of america. BMI additionally doesn’t take into account elements equivalent to muscle mass. “This was supposed to explain massive teams of individuals; it was not supposed to be a person litmus take a look at for well being,” says Leah Graves, a registered dietitian who makes a speciality of treating consuming problems. Graves and others query whether or not BMI affords households helpful details about college students’ general well being.
The varsity insurance policies quickly bumped into one other downside: There wasn’t a lot proof that they labored.
Not lengthy after the NAS suggestion was launched, scientists started publishing research on faculty weigh-ins. In 2009, as an illustration, two pediatrics specialists printed a assessment of the prevailing analysis, discovering that there was no affect on college students’ weight. Dad and mom, they wrote, didn’t appear to be studying a lot from BMI report playing cards, and there didn’t appear to be any improve in wholesome behaviors at house.
In 2014, Madsen, the UC Berkeley researcher, and a number of other of her colleagues launched a randomized scientific trial. The researchers took practically 29,000 college students in California public elementary and center faculties and cut up them into three teams. One group didn’t get screened in any respect. The second was screened, however members by no means discovered the outcomes. A 3rd group acquired screenings, and the members’ caregivers have been despatched BMI report playing cards. The researchers adopted the group from 2014 to 2017 to trace modifications in weight and antagonistic outcomes.
The group’s outcomes, printed in 2021, confirmed that neither screening nor reporting had an affect on weight change over time. Moreover, the 2 teams that have been screened reported extra weight dissatisfaction and peer weight speak than the group that wasn’t screened.
Madsen’s analysis has additionally discovered that the expertise may be upsetting for college students. In a single 2022 survey of greater than 11,000 college students in California, her group discovered that 49 % have been weighed by fitness center lecturers, versus simply 28 % who have been weighed by faculty nurses; the scholars have been extra prone to really feel much less snug being weighed by a trainer than by a nurse, and have been extra prone to really feel that they lacked privateness whereas being weighed.
Different analysis has documented the potential for long-term harms from that have. The adverse results of adolescents perceiving themselves as obese can final for years into maturity, lengthy after the screenings have ended, in accordance with one 2023 survey. Though the examine didn’t particularly ask about BMI screening, it linked a perceived obese standing to elevated self-starvation, bingeing, purging, and overexercising, in addition to the event of consuming problems.
Not each knowledgeable is satisfied that BMI screening for the sake of knowledge assortment is essentially dangerous. Researchers and college professionals say that it’s the way in which these screenings are performed that may trigger issues. In consequence, some skilled organizations and authorities companies have issued tips supposed to enhance the expertise.
The Facilities for Illness Management and Prevention, which has no formal place on BMI screenings, has a public set of 10 safeguards faculties can implement to handle issues about screenings. The checklist consists of suggestions equivalent to measuring college students’ peak and weight in a non-public place, having nurses as a substitute of lecturers take the measurements, and asking for parental consent earlier than measuring college students.
However a 2019 CDC survey of greater than 200 faculties discovered that these safeguards had not been broadly carried out. Solely 3 % of the colleges had no less than 4 of the safeguards in place, and 19 % had no safeguards in any respect.
“These safeguards got here out sort of pragmatically, recognizing that there’s not sufficient proof at that time to say whether or not or not BMI-measuring faculties is definitively dangerous or useful, however faculties are doing it,” says the CDC school-health researcher Sarah Sliwa. “So, in the event that they’re doing it, what are some steps they’ll take to attempt to decrease these harms and improve the probability that knowledge are collected in a approach that’s clear and helpful?”
As the varsity employees members who’re most frequently requested to weigh college students, bodily educators have additionally developed requirements relating to physique measurement in faculties.
The Society of Well being and Bodily Educators, or SHAPE America, an expert group, has a formal assertion on health testing—which might embody BMI screenings, amongst different assessments—that states that the group finds the testing worthwhile solely when it’s built-in appropriately into the curriculum, and when the outcomes aren’t used to grade college students. SHAPE America recommends that faculties first train college students in regards to the health testing and why it’s accomplished, in addition to put together them for the method and assist them set customized targets based mostly on the result of the testing. However the group doesn’t have an official suggestion on whether or not to conduct BMI screenings.
“There’s a whole lot of physique stigma, and we now have different knowledge factors that we are able to use with out having college students really feel that they’re being judged,” says Cara Grant, the president of SHAPE America.
The American College Well being Affiliation, a corporation of college nurses and different well being professionals, additionally doesn’t have an official place on BMI screenings, says Kayce Solari Williams, ASHA’s former president.
To be able to successfully notice the CDC tips, Sliwa says, faculties must implement safeguards or finest practices. Due to an absence of the funding and staffing, although, they usually fail to take action.
Some states have responded to the analysis exhibiting harms from BMI screenings. In 2013, Massachusetts struck BMI reporting from its faculties however maintained a screening requirement. Illinois made BMI screening optionally available for its college students in 2015. California eradicated screening and reporting necessities from its annual health testing. In New York, faculties nonetheless display for BMI, however they’re not required to ship BMI report playing cards house.
Different states haven’t made modifications. In Georgia, screening and reporting are required by legislation. In West Virginia, which has among the highest ranges of childhood weight problems within the nation, state legislation requires the gathering of BMI knowledge to be reported to the Division of Schooling, the governor, the State Board of Schooling, the Wholesome Life Coalition, and the Legislative Oversight Fee on Well being and Human Sources Accountability.
In New Jersey, the place Manion attended highschool, BMI screening just isn’t mandated, nevertheless it’s allowed on a district-by-district foundation. The state does require weight measurement, nevertheless.
“What’s the worth?” asks Madsen, the UC Berkeley researcher. She questions whether or not the insurance policies are an excellent use of college sources. “All the level of sending them house is definitely to assist households in creating more healthy existence,” she says. “However they’re not.”
Amanda Salazar is a contract journalist from Brooklyn, New York.
